31例冠心病患者双导丝聚力球囊单纯扩张小血管病变8年随访观察

Observations on 8 years clinic outcomes of patients using with dual-wire focused force angioplasty for lesions in small coronary arteries

目的:探讨采用双导丝聚力球囊单纯扩张的介入治疗方法,处理直径≤2.5 mm小血管病变的远期预后。方法:筛选因"急性冠状动脉综合征"入院,冠状动脉造影显示冠状动脉病变中至少含有1支小血管病变(参考血管直径≤2.5 mm)需行介入治疗的患者。入选其中小血管病变介入治疗方案采用双导丝聚力球囊单纯扩张,并且包括小血管病变在内的全部冠状动脉病变介入治疗成功,无手术并发症;同时,术后6～9个月复查冠状动脉造影或冠状动脉CT血管造影(CTA)且资料完整的31例患者。统计小血管病变再狭窄发生率。随访8年,采用欧洲五维健康量表(EQ-5D)进行生活质量测评,观察其生活质量改善及主要心血管事件发生率。结果:6～9个月时复查的冠状动脉CTA,结果显示2例患者出现不足70%的再狭窄,因患者无典型心绞痛症状及心电图相关导联动态ST-T改变的心肌缺血证据,未行再次血运重建术。全部患者介入治疗术后5年内无典型心绞痛症状,生活质量均明显改善,EQ-5D评分接近100分,无主要心血管事件(MACE)事件。介入治疗的5年后,18例患者开始出现逐渐加重的心肌缺血症状,8例患者因急性冠状动脉综合征再次入院行靶血管再次血运重建术。全部患者无死亡、心肌梗死等恶性事件。EQ-5D评分虽低于5年内评分水平,但仍明显高于术前。结论:采用双导丝聚力球囊单纯扩张的介入治疗策略处理直径≤2.5 mm小血管病变5年内预后良好,无MACE事件,明显改善生活质量。MACE事件的发生主要集中在5年后。主要不良事件为再次靶病变血运重建。

Objective：The goal of this study was to assess the clinical benefits of dual-wire focused force angioplasty for lesions in small coronary arteries. Methods：We observed 31 patients with unstable angina （ reference vessel ≤2. 5 mm in diameter） who achieved dual-wire focused force angioplasty success without ves- sels complications. All of them performed follow-up angiography or coronary CTA after 6 months. Restenosis, major adverse cardiac event （MACE） and life qualities being calculated with EQ-SD self-rating scales were as- sessed. Results：Within 5 years after intervention, good clinic outcomes were observed. Patients got life quali- ties improvements without symptom and adverse cardiac event. Mild restenosis （ 〈 70% ）. occurred in 2 Patients without target lesion revascularization. After S years, 18 patients started to complain progressive angina. 8 of them were treated with revascularization. EQ-5D self-rating score got worse than that after pereutaneous coro- nary intervention （ PCI）, but still better than that before procedural. There is no death or acute myocardial in- farction during 8 years. Conclusion：These findings showed that dual-wire focused force angioplasty for lesions in small coronary arteries provides superior clinical outcomes including life qualities improvements especially within 5 years after intervention. Target lesion revascularization, as the major adverse cardiac event, is more common after 5 vears.